Identification Number:
GN 04440 TN 106
Intended Audience:See Transmittal Sheet
Originating Office:OARO Office of Quality Review
Title:Federal Quality Review of Disability Determinations
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part GN – General
Chapter 044 – Quality Appraisal
Subchapter 40 – Federal Quality Review of Disability Determinations
Transmittal No. 106, 07/10/2020

Audience

PSC: DE, DEC;
OCO-OEIO: FDE;
DQB: DE, PL;
OCO-ODO: DE, DEC, DS, RECONE;

Originating Component

OQR

Effective Date

Upon Receipt

Background

The control language has been corrected. This is a Quick Action Transmittal and the changes does not produce new policy or procedure.

Summary of Changes

GN 04440.247 Reviewing Informal Remand Cases

The control language was deleted because it was incorrectly instructing quality reviewers to not control the return.

GN 04440.247 Reviewing Informal Remand Cases

A. Introduction to informal remand procedure

The informal remand procedure was developed to provide a pre-hearing case review for hearing cases that have a strong likelihood of reversal of the adjudicating component’s initial or reconsideration determination. Either the field office (FO) or the Office of Disability Adjudication and Review (ODAR) generally identifies informal remand cases. When the FO identifies the case as an informal remand, they send it to the adjudicating component that made the unfavorable determination rather than to the ODAR hearing office. When ODAR identifies a case as an informal remand case, they forward the case to the adjudicating component.

For adjudicating component procedures, see DI 27520.001 and DI 27520.005.

NOTE: If the FO identifies the case as an informal remand, the case will be a paper case because this situation is exempt from electronic processing.

If ODAR identifies the case as an informal remand, the case can be a paper case or a certified electronic folder (CEF) case. The Office of Quality Review (OQR) does not sample paper cases.

B. Process for reviewing informal remand cases

When the adjudicating component can make a fully favorable allowance, they prepare a reopening of the unfavorable initial or reconsideration determination.

Informal remand fully favorable allowance cases are subject to sampling for the pre-effectuation review, but are not subject to sampling for the quality assurance (QA) reviews. Consequently, there are no informal remand cases in the QA sample.

Informal remand cases are identified in the alerts and messages section in eView.

C. Procedure for reviewing informal remand cases

Review informal remand cases the same as any reopening determination, following regular review procedures with the following modifications.

NOTE: The adjudicating component is working under specified time frames to complete action on informal remands. The review component must do everything possible to ensure that quality review does not delay the completion of the case.

1. Payment effectuation

Do not effectuate the informal remand determination. The FO effectuates payment and holds the case for 45 days pending claimant's request to proceed with the hearing. For procedure on processing fully favorable determinations, see DI 12010.025B.

2. Notices

The adjudicating component does not release the notice(s) because the Office of Quality Review selected the informal remand case for quality review.

Release the notice(s), as appropriate. ODAR will receive an electronic notification of the determination.

3. Routing

Return the case to the adjudicating component if a documentation deficiency has the potential to result in an affirmation of the denial or a less than fully favorable determination. If the adjudicating component finds the case cannot be reopened and a fully favorable determination is made after taking corrective action per the deficiency citation, the adjudicating component must return the case to ODAR for the hearing.

4. Deficiency returns

If you need to return the case to the adjudicating component for corrective action advise the adjudicating component in the SSA-1774-U5 to return the case to ODAR if corrective action results in an affirmation of the denial or a less than fully favorable determination.


GN 04440 TN 106 - Federal Quality Review of Disability Determinations - 7/10/2020